Achieving Health Equity From planning to action

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Achieving Health EquityFrom planning to action

• Ana Novais, MA
• Peter Simon, MD, MPH
• Division of Community, Family Health Equity
• Rhode Island Department of Health
• CityMatCH, September 2011

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Situation Review

• For the first time in modern years, the next
• generation (our childrens generation) has a
• lower life expectancy than the previous
• generation

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Situation Review - Healthy RI 2010

• Summary of Changes from 2004 to 2007 Reports
• Native American 5? 7? 6?
• African American 12? 11? 7?
• Asian Pacific Islander 9? 11? 4?
• Hispanic Latino 12? 13? 5?
• State Overall 12? 14? 4?

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Health Equity Quiz
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CFHE Vision

• CFHE aims to achieve health equity for all
• populations, through eliminating health
• disparities, assuring healthy child
• development, preventing and controlling
• disease, (including HIV/AIDS and Viral
• Hepatitis), preventing disability, and working to
  
• make the environment healthy.

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Community, Family Health Equity

• Community- because all health is local
• Family- because families are our key partners in
  health
• Equity- because our mission is to assure that all
  Rhode Islanders will achieve optimal health

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Community, Family Health Equity

• Our values guide us in the work we do internally
  and with our key partners
• Diversity
• Health Equity and social justice
• Open communication
• Team work
• Accountability
• Data driven science based

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CFHE Priorities

• Health Disparities and Access to Care
• Healthy Homes and Environment
• Chronic Care and Disease Management
• Health Promotion and Wellness
• Perinatal, Early Childhood and Adolescent Health
• Preventive Services and Community Practices

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CFHE Equity Framework

• Social and environmental determinants of health
• Lifecourse developmental approach
• Program integration
• Social and emotional competency

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Social and Environmental Determinants of Health

• Determinants of health range of personal,
  social, economic, and environmental factors that
  influence health status.
• Biology
• Genetics
• Individual behavior
• Access to health services
• Environment
• Age

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Social Determinants of Health

• Social determinants of health are life-enhancing
  resources, such as
• food supply, housing, economic and social
  relationships, transportation,
• education, and health care
• whose distribution across populations and
  communities effectively determines length and
  quality of life for the individual, the community
  and the population.

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SDH Education

• In Rhode Island in 2009, the median income of
  adults without a high school diploma or GED
  certificate was 20, 547 compared to 28, 785 for
  people with a high school degree, and 48, 845
  for those with a bachelors degree.
• Source Kidscount.org

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SDH Education

• Dropout rate in RI by race and ethnicity in 2010
• RI US
• RI vs. National 14 8.1
• White 11 5.2
• Asian 13 3.4
• Black 20 9.3
• Hispanic 22 17.6
• Native American 18 13.2
• Source 2011 RI KIDS COUNT U.S. Department of
  Education, National Center for Education
  Statistics. (2011). The Condition of
  Education 2011 (NCES 2011-033), Indicator 20.

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SDH Poverty

• In RI (2005-2009 American Community Survey 5-Year
  Estimates)
• Under 18 years old 16.7
• 18-64 years old 10.3
• 65 years and over 9.4
• Live below poverty level

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SDH Poverty Race

• Below poverty level by race, ethnicity and gender
• White 8.8
• Black 24.4
• American Indians 23.6
• Asian 16.4
• Hispanic 28.6
• Gender
• Male 10.5
• Female 12.7

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Life Course Developmental Approach

• Todays experiences and exposures influence
  tomorrows health (Timeline)
• Health trajectories are particularly affected
  during critical or sensitive periods (Timing)

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Life Course Developmental Approach

• The broader community environment- biological,
  physical, and social- strongly affects the
  capacity to be healthy (Environment)
• While genetic make-up offers both protective and
  risk factors for disease conditions, inequality
  in health reflects more than genetics and
  personal choice (Equity)

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Lifecourse Framework
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Example of the Life Course Approach in Obesity
Prevention

• (Source Mary Haan, DrPH, MPH, University of
  Michigan. Adapted from World Health
  Organization, Life course perspectives on
  coronary heart disease, stroke and diabetes Key
  issues and implications for policy and research.
  Summary Reports of a Meeting of Experts, 24 May
  2001. ) Available at http//whqlibdoc.who.int/hq/
  2001/WHO_NMH_NPH_01.4.

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Integration Projects Umbrella
Division of Community, Family Health
Equity Integration Projects Umbrella
ARRA CDC Communities Putting Prevention to
Work Initiatives
New (CCD) Coordinated Chronic Disease and CTG
Grants
CDC Team Works Project DCFHE Healthy Communities
Pilot Project in Olneyville
Multiple DCFHE Policy and Practice Integration
Efforts
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CFHE Integration Initiative

• Provides for consistency in approaches, data use
  and evaluation to address common
• Socio-economic determinants of health and health
  equity issues
• Population risk and protective factors
• Opportunities in venues like CBOs, FBOs,
  workplaces and schools, health care and other
  systems

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CFHE Integration Initiative

• Common vision
• Joint leadership
• Joint planning and quality initiatives
• Common outcomes
• Common policies
• Common financing and implementation at the state
  and local level

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Common Vision

• Creates a common vision of a healthy community
  that will increase HEALTHs impact
• HEALTH EQUITY FOR ALL

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Joint Leadership

• Joint problem solving and decision making
  mechanisms (MOUs, policy advisory groups,
  facilitation, criteria for priority setting,
  etc.)
• Weekly leadership meetings
• Monthly program manager meetings
• Policy work group meetings

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Joint Planning Quality

• Assessment, monitoring, technology tools common
  assessment tools that address subpopulations
  across the life span.
• Community input/feedback
• Evaluation
• Dissemination of information

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Common Outcomes

• Performance measures, and/or proxy measures of
  success - behavioral, risk and protective
  factors, diseases and conditions, injuries,
  well-being and health-related Quality of Life and
  Equity.
• Categorical data layered by populations across
  life course, geographic areas, income,
  race/ethnicity, etc.
• Different look at surveillance and data analysis
  Providence DataHub

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Common Policies

• Common legislative and policy agenda.
• Common communications messages with integrated
  information and education activities.
• Integrated advocacy strategies.
• Common mechanisms for community input and
  empowerment, integrated training/TA, and capacity
  building of community advocates.

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Common Financing Implementation

• Joint leveraging of funds
• Integrated initiatives and common strategies by
  community, population, and/or settings, supported
  with pooled Federal, state and/or state private
  categorical funds using integrated RFPs and
  contracts
• Joint management of activities

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Hands on Exercise

• Work plan assessment using Pyramid and four
  questions

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4 Equity Questions

1. What does achieving health equity means for
   your program/team?
2. How comprehensive are your interventions
   (meaning, are your interventions reaching all
   five levels of the Equity Pyramid?)
3. If you are not addressing all levels of the
   pyramid, why not? What else are you doing?
4. What support will your program/team need in order
   to develop a comprehensive public health program,
   which addresses all levels of the pyramid?

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CFHE Strategic Challenges

1. Build a shared public health equity agenda across
   the state
2. Adopt a community development frame for our work
3. Transform comprehensive service delivery model
   and culture of service delivery
4. Build capacity to collaborate internally

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CFHE Next Steps

• Meeting with Teams
• 4 Equity questions
• Grants review
• Local investments
• Staff training
• Equity workgroup
• Responding to the 4 Strategic Challenges

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Strategic challenge 1 - update

• Building a shared public health equity agenda
• across the state
• On-going effort (presentation at key community
  events and with key constituencies)
• CFHE Booklet

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Strategic challenge 2

• Adopt a community development frame for our
• work
•  CFHE has completed several local assessment
  processes and is working with three communities
  to develop community driven action plans and
  activation based on the results from the
  assessments. 
• CFHE adopted a coordinated approach to community
  engagement and advocacy training across the
  division.
• MCH Block Grant Local Initiative RFP

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Strategic challenge 3

• Transform comprehensive service delivery model
• and culture of service delivery
• Several initiatives are being implemented across
  the division with the home visiting program,
  healthy homes initiative, Chronic Care
  Collaborative (to name a few) so CFHE presence at
  the local level is coordinated and we are more
  effective in our approach.
• Alignment of CTG proposed strategies/interventions
  with proposal for CCDHP grant

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Strategic challenge 4

• Build capacity to collaborate internally
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• On-going activity. Examples
• Health equity grant checklist
• Equity pyramid exercise with Teams  
• Core competency training  
• Standardization of local assessment tools 
• Asset mapping project
• MCH Block Venture Capital

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Hands on exercise

• Use of grants check list

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Implementation examples

• Tobacco /Pregnancy Risk Assessment Monitoring
  Survey (PRAMS)
• Healthy Living Campaign (Diabetes/Obesity)
• Healthy Housing (Lead, Asthma, Radon, Asbestos)
  Healthy Housing Strategic Planning Process
  Refugee Housing Workgroup
• Special Populations Emergency Response (Minority
  Health and Disabilities)

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Implementation examples

• Olneyville Project (Office of Minority Health,
  Initiative for Healthy Weight, Healthy
  Communities, Prevention Block Grant Community
  Planning)
• Community Skills Capacity Building (Office of
  Minority Health, Tobacco Control Program,
  Initiative for Healthy Weight, Office of
  HIV/AIDS)
• HPV (Immunization Program, Womans Cancer
  Screening Program and Adolescent Health)

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Implementation examples

• Chronic Care Collaborative(Heart Disease
  Stroke, Asthma, Cancer, Diabetes)
• HIV/STDs (Renew Program)
• Lead/Refugee Health
• Workforce Development Project

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CFHE Local Investments
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Healthy Rhode Island 2010 banners
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Questions?Ana P. NovaisPeter Simon(401)
222-1171ana.novais_at_health.ri.govpeter.simon_at_heal
th.ri.gov Resourceswww.health.ri.gov
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Social Environments as Determinants of Health
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Social Environments as Determinants of Health
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Community and Physical Environments